Client Contact Information

Referral Information

Consent for Release of Information

In an effort to coordinate services, I hereby authorize the service provider named in section 3 to share and/or release any applicable information pertaining to my participation in services.

I acknowledge that the referring service provider may be notified once I have made contact withthe referred service organization. I understand that I may, in writing, change or cancel this authorization at any time, except for such action as has already been taken.

As it pertains to referrals from Ontario Works, MFIPPA applies:

I acknowledge that my personal information may be shared with various program participants as contemplated by s.14(1)(a) of the Municipal Freedome of Information & Protection of Privacy Act, R.S.O. 1990, CHAPTER m.56; I understand that the treatment, storage, and handling of my personal information is governed by the Municipal Freedome of Information & Protection of Privacy Act, R.S.O. 1990, CHAPTER m.56.

Disclaimer

Lambton College Community Employment Services ensures that your privacy will be protected by following the Personal Information Protection and Electronic Documents Act(PIPEDA). Information is collected, used and disclosed for the purpose of employment/training/service coordination to ensure your academic/employment goals are met. If at any time you have any questions/concerns or complaints related to Lambton College privacy policy and the treatment of your personal information please contact 519-882-4333.